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APPLICATION FORM

Pertukaran Pemuda Antar Negara (PPAN) Provinsi Jawa Tengah
2014
F
A. OFFERED PROGRAMS*
I am applying for (give a check mark (√) in only one program)
Ship for Southeast Asian Youth Program (20-30 year old per 1 August 2014)
Please provide color
photograph
√ Indonesia Canada Youth Exchange Program (18-23 year old per 1 August 2014)
Australia Indonesia Youth Exchange Program (21-25 year old per 1 August 2014)
Indonesia-Malaysia Youth Exchange Program (23-27 year old per 1 August 2014)
Indonesia-Korea Youth Exchange Program (18-24 year old per 1 August 2014)
B. PERSONAL INFORMATION
Full Name DIAH AYUNINGRUM
Place, Date of Birth REMBANG, MAY 21
ST
, 1994
Age (per 1 August 2014) 19
Gender FEMALE
Address (as in KTP) Ds. Sluke RT.03 RW. III, Sluke, Rembang, Jawa Tengah, Indonesia
Phone/Mobile Number 085729798388
Email dhiyah21@yahoo.com
Twitter ID (if any) @dhee_dee
C. EDUCATION
Starting from senior high school to most recent education
Year Institution Major
2008 SMA N 1 REMBANG IPA
2011 UNIVERSITAS NEGERI SEMARANG BIOLOGY EDUCATION
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INSTRUCTIONS:
1. Please read carefully before filling in this application form
2. Please fill in the form and answer all the question in English
3. Please send the application form together with scanned copies of TOEFL certificate, KTP, and
supporting documents to pcmijateng@gmail.com not later than Thursday, 10 April 2014 at 23.00
4. For further inquiries regarding this application process, please contact us at pcmijateng@gmail.com
5. Please refer to http://pcmijateng.com for further information about the exchange programs
APPLICATION FORM
Pertukaran Pemuda Antar Negara (PPAN) Provinsi Jawa Tengah
2014
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D. ACHIEVEMENTS
Please mention your 5 (five) most remarkable achievements
Year Achievements Level/Scope
(International / National / Province / District)
2014 Volunteer of IBO 2014, Bali, Indonesia International
2013 Juara II Kategori Teori OSN Pertamina Bidang
Biologi
Province
2012 Semifinalis OSN Pertamina kategori Teori Bidang
Biologi
Province
2010 Peserta OSN Biologi kemendikbud Province
2010 Juara II OSN Biologi Kemendikbud District
E. ORGANIZATIONAL EXPERIENCES
Please mention your organizational experiences in the last 5 (five) years
Year Name of Organization Position Description of your
Your Duties in the Organization
2014 Jasmina Study Center (JSC) MPO (Majelis Pertimbangan
Organisasi)
Give a consideration for that chief to
make a discision
2013 Jasmina Study Center (JSC) Head of Human Resources
Development (HRD)
Department
Coordinate and show the way to make
JSC solid, give the way for recruitment
young members.
2012 Jasmina Study Center (JSC) Secretary of Human Resources
Development (HRD)
Take care the administration of some
invitation in my department, lead my
department if my head can’t do for
some reason.
2013 Familia Staff of Eduskill Create an event to develop the
akademik and skill of biology student’s
2012 Familia Staff of Sosdanus Create an event to make money for the
2 Purna Caraka Muda Indonesia (PCMI) Jawa Tengah
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APPLICATION FORM
Pertukaran Pemuda Antar Negara (PPAN) Provinsi Jawa Tengah
2014
F
organization
2012 UKM Boga Member Follow some event to develop my skill
in cooking and creting some new recipe
of foods.
F. SOCIAL ACTIVITIES
Please mention any social contribution activities or community services that you have been involved
Year Activity Institution Location
H. PERSONAL ESSAYS
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APPLICATION FORM
Pertukaran Pemuda Antar Negara (PPAN) Provinsi Jawa Tengah
2014
F
1) What motivates you to apply for this program? (Maximum 100 Words)
I wanna join this program because i wanna give contribution to promote the beautiful Indonesia to the
international world. To share the culture especially central java with another country. To introduce them
how amazing Indonesia is. Being a delegation of Central Java is such great thing in mylife. It will teach some
of the new thing i’ve never get in my college. A new experience to me if i can be central java delegation. So
that to make it true, i will try my best.
2) What are the strengths that make you a qualified candidate for this program? What are your weaknesses
and how do you overcome them? (Maximum 150 Words)
I able to communicate in english well. I know the main culture of central java.
4 Purna Caraka Muda Indonesia (PCMI) Jawa Tengah
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3) What challenges have you overcome in pursuing your educational/professional goal OR in undertaking
social contribution activities? (Maximum 100 Words)
APPLICATION FORM
Pertukaran Pemuda Antar Negara (PPAN) Provinsi Jawa Tengah
2014
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I hereby declare that all information stated above is true and I bear full responsibility of any
possible consequences related to the truthfulness of this information.
Date:_ Signature of Applicant:
5 Purna Caraka Muda Indonesia (PCMI) Jawa Tengah
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4) If you are selected as the next delegate, how will you apply your newly
acquired skills and knowledge to develop your region/community? (Maximum 200 words)
APPLICATION FORM
Pertukaran Pemuda Antar Negara (PPAN) Provinsi Jawa Tengah
2014
F

6 Purna Caraka Muda Indonesia (PCMI) Jawa Tengah
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